Evaluating Saudi Nursing Students’ Knowledge and Attitudes toward Cancer Pain Management...

D.Y. Wazqar
ORIGINAL ARTICLE

Evaluating Saudi Nursing Students’

Knowledge and Attitudes toward Cancer
Pain Management: Implications for Nursing
Education
Dhuha Y. Wazqar, PhD, RN
Department of Medical Surgical Nursing, Faculty of Nursing
King Abdulaziz University, Jeddah, Saudi Arabia

Correspondence Abstract
Dr. Dhuha Y. Wazqar Ineffective pain management has been recognized as a major problem
Department of Medical Surgical Nursing
Faculty of Nursing, King Abdulaziz University faced by many patients with cancer. There is a lack of emphasis on
P. O. Box 24828, Jeddah 21551 cancer pain management in the undergraduate nursing curriculum
Saudi Arabia which is one part of this problem. A descriptive cross-sectional study
e-M: dwazger@kau.edu.sa was carried out with a convenience sample of 135 nursing students
at two universities in Jeddah, Saudi Arabia, to evaluate students’
Submission: 11 Nov. 2019
Accepted: 03 Dec. 2019 current knowledge and attitudes toward cancer pain management.
Data were collected using Pain Management Principles Assessment
Citation Test and Nurses’ Pain Management Attitudes Survey. The data were
Wazqar DY. Evaluating Saudi nursing students’ analyzed using IBM Statistical Package for the Social Sciences version
knowledge and attitudes toward cancer
pain management: implications for nursing 22, and P < 0.05 was interpreted as significant. Descriptive and
education. JKAU Med Sci 2019; 26 (2): 61-70. inferential statistics and Pearson correlations were performed. Nursing
DOI: 10.4197/Med.26-2.7 students have insufficient knowledge (11.4 ± 2.92) and negative
attitudes (68.8 ± 5.75) toward cancer pain management. None of the
nursing students achieved complete, correct responses (31 or 100%)
Copyright: ©The Author(s), YEAR. Publisher. The Journal of King
Abdualziz University - Medical Sciences is an Official Publication of in the knowledge test. Students had poor knowledge regarding
“King Abdulaziz University”. It is an open-access article distributed
under the terms of the Creative Commons Attribution Non-Commercial areas of pain physiology and assessment, pharmacologic and non-
License, which permit unrestricted non-commercial use, distribution, and
reproduction in any medium, provided the original work is properly cited. pharmacologic pain management such as cutaneous stimulation. A
weak positive significant relationship between students’ knowledge
and attitudes was also found (r = 0.225, P = 0.009). Continued work
is required to develop specific strategies to effectively teach nursing
students and enhance their knowledge and attitudes toward cancer
pain management.

Keywords
Attitudes; Cancer pain management; Knowledge; Nursing students;
Nursing education

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 Evaluating Saudi Nursing Students’ Knowledge and Attitudes toward Cancer Pain Management...
D.Y. Wazqar
Introduction
R
elieving cancer pain is a global health problem
that requires immediate attention[1]. The British
Pain Society has defined cancer pain as a complex and
multi-dimensional experience including acute and
chronic pain that reflects both damage to the body and
the body’s response to the damage[2]. Cancer pain is
caused by tissue injury due to cancer itself, diagnostic
procedures, or cancer treatment modalities such
as surgery, radiation therapy, and chemotherapy[3].
Moderate to severe pain is a common distressing
symptom throughout the cancer trajectory, and the
prevalence of this pain increases throughout the
course of illness[4]. Seventy percent of the terminally ill
cancer patients, and 30% to 50% of patients receiving
cancer treatment suffer from chronic pain whereas
pain persists for 33% of cancer survivors[5,6]. A study
conducted on cancer patients recruited from oncology
units of a university hospital in Riyadh, Saudi Arabia, on
palliative care service found that 51% of participants
experienced moderate to severe pain[7].
Unmanaged cancer pain can negatively impact
the quality of life of patients, families, and caregivers
including mental distress (depression and anxiety),
sleep disturbance, social isolation, functional disability,
and immobility[3]. Also, it increases the burden on
healthcare providers and hospitals due to prolonged
duration of hospitalization, increased re-admission
rates, and increased healthcare expenses[8]. Adequate
cancer pain management is the cornerstone of
symptom management for cancer patients[4]. Although
World Health Organization (WHO) guidelines and
recommendations for cancer pain management were
issued more than twenty years ago, a considerable
amount of evidence suggests that the management of
cancer pain is often sub-optimal in Saudi Arabia[7, 9].
There are many problems that hinder effective
cancer pain management in Saudi Arabia. Factors
related to health care providers’ knowledge and
attitudes seem to play a significant role. Previous
studies have demonstrated that Saudi nurses lack
adequate knowledge and proper attitudes for
managing cancer pain effectively leaving many
patients to suffer[10,11]. Researchers also reported sub-
optimal cancer pain management by nurses is due to
poor pain assessment, inadequate knowledge, and
negative attitudes together with insufficient guidance
from cancer pain consultants in Saudi hospitals[12,13].
Another study explored pain knowledge and attitudes
62 Journal of King Abdulaziz University - Medical Sciences  Volume 26 No. 2, 2019
of 255 healthcare providers and found that the nurses
abstained from giving opioids to their patients because
of a fear of respiratory depression and addiction[14].
Furthermore, a lack of knowledge among Saudi
nurses about the concepts related to cancer pain
management strategies and the non-pharmacological
and pharmacological interventions to manage it was
noted[10]. This lack of knowledge and the negative
attitudes demonstrated by nurses from the previous
studies results from deficiencies in their formal training
and continuing professional development.
Prior research has suggested that barriers to
effective cancer pain management might be due
to a lack of training specific to cancer pain and pain
management[15,16]. This has subsequently led to negative
attitudes toward cancer pain management due to fear
of liability, unfamiliarity, and anticipated risks that
might include respiratory depression, dependence,
and addiction[11,15]. Nurses with insufficient cancer
pain management training/education cannot deliver
proper care to patients that are suffering from pain—
particularly in oncology units where cancer pain
management is an important element of nursing
care[16].
There is limited literature on the knowledge
and attitudes of nursing students during their
undergraduate training in Saudi Arabia. This includes
a lack of insight into effective management of cancer
pain during clinical training. In Saudi nursing programs,
cancer pain and pain management are normally
discussed in different courses including physiology,
pharmacology, and medical-surgical nursing. There
is also a lack of formal pain management and cancer
nursing courses in undergraduate nursing curriculum
in colleges. This can hinder graduate nurses’ ability to
properly manage and assess cancer pain. The effect
of this on the level of knowledge and attitudes of
nursing students towards cancer pain management
has never been examined in Saudi Arabia. A literature
search identified only one study conducted among
Saudi medical students[17]. It is therefore necessary to
understand nursing students’ foundation of cancer pain
management and attitudes that are then translated
into clinical practice. The purpose of this study was
to evaluate the current knowledge and attitudes of
Saudi nursing students who have passed physiology,
pharmacology, and medical-surgical nursing core
courses focused on cancer pain and pain management
contents. The study details the strengths and
weaknesses of nursing students regarding cancer pain
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 Evaluating Saudi Nursing Students’ Knowledge and Attitudes toward Cancer Pain Management...
D.Y. Wazqar
management. It can also help modify undergraduate
nursing programs for an improved emphasis on cancer
nursing and pain management courses.
Methods
A descriptive cross-sectional design was used to
evaluate the knowledge and attitudes of 135 female
nursing students (convenience sample) toward
cancer pain management across two universities in
Jeddah City, Saudi Arabia. The target population was
final year nursing students registered in the selected
universities. Approximately 207 nursing students who
met the inclusion criteria enrolled in the universities.
The two universities have the same nursing academic
systems, policies, and procedures and follow the
Saudi Arabian Ministry of Education accreditation of
higher education. The selection of the participants in
this study was based on the following criteria: must
be willing to participate; must be registered students
at one of the universities; must have completed the
third year of their undergrad nursing study (as these
students are likely to be finishing the most important
part of their clinical training); and must have passed the
physiology, pharmacology, pathology, and medical-
surgical nursing courses.
Nursing students’ knowledge was assessed by
the Pain Management Principles Assessment Test
(PMPAT)[18]. This instrument is a multiple-choice quiz
(31 questions) with four responses for each question.
This was used to assess pain management knowledge
regarding pharmacology, physiology, and pain
characteristics such as principles of management,
tolerance, physical dependence, and addiction. The
PMPAT scores ranged from zero to 31 and were then
calculated to a percentage score from zero to 100
with lower scores indicating that many questions
were incorrectly answered. The instrument validity
was confirmed among 28 nursing students using a
pre and post-test technique before and after taking a
pain management module (t = 6.76, P < 0.001)[18]. In
addition, the reliability of the instrument (r = 0.84, P <
0.001) was established using test-retest reliability with
a delay of one week[18]. More than 60% is considered a
passing score on the PMPAT.
The Nurses’ Pain Management Attitudes Survey
(NPMAS) assessed attitudes of nursing students toward
cancer pain management in this study. The NPMAS is a
25-item tool developed by McMillan et al.{19} and rated
on a 4-point Likert scale (strongly agree, agree, strongly
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disagree, and disagree). A lower score indicates more
attitudinal problems among nursing students. The
questionnaire involves items on pain assessment and
its goals, the use of narcotics, scheduling analgesics,
non-pharmacologic interventions of pain, and some
misconceptions about cancer pain management.
Validity was further confirmed by comparison of nurses’
scores at different levels of expertise that included
senior pain experts, graduate students, oncology
nurses, new graduates, and students. Cronbach’s alpha
of the NPAS was adequate (P = 0.70)[19].
Permission to use PMPAT and NPMAS tools was
obtained. The investigator used the English version
of the questionnaires because English is the official
language of education at the nursing colleges in
Saudi Arabia. Finally, the demographic data collected
included age, previous training or workshops/lectures/
advanced courses of cancer pain management outside
the university (“Yes” or “No”), and previously cared for
cancer patients in pain (“Yes” or “No”).
Ethical approval was obtained from the universities’
research ethics committees prior to data collection.
One condition was not mentioning the names of
the universities in any conference presentations or
publication to protect their reputations among other
competitive nursing colleges in Saudi Arabia. The data
were collected 11-30 March 2018. A brief description
of the study was provided to the students noting that
there were no benefits and or risks to nursing students
for participating. Students who agreed to be involved
in the study were asked to sign a written consent form.
During scheduled class time, study questionnaires
were given to the participants who were asked to read
the information and then complete the questionnaires
separately without the assistance of colleagues or
textbooks. The researcher was present in the classroom
to respond to any questions or concerns related to
the study. Questionnaires took on average 25 minutes
for participants to complete. The questionnaires were
collected at the end of the class by the investigator and
kept in a locked drawer in her office and were used only
for research purposes. Soft and electronic copy data
were also saved on a high-quality hard drive that was
encrypted and protected with a password and kept in
a safety cabinet. There were no personal identifiers on
the questionnaires. IBM Statistical Package
for the Social Sciences (SPSS) version 22 (IBM Corp,
Armonk, NY) was used for statistical analysis. Means,
standard deviations (SD), percentages, and frequencies
were used to describe the participants’ characteristics
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D.Y. Wazqar
and their answers to the questions in the survey.
Also, the independent t-test and Pearson correlations
were used. Cronbach’s alpha reliability analysis was
performed for the tools to identify internal consistency.
The level of significance was set at a P-value of < 0.05
in all analyses. If students did not answer any question
(N = 32), this question was coded as an incorrect
answer, comparable to how it would be marked in the
classroom test situations.
Results
Of the 207 nursing students currently in their final
year of nursing asked to participate in this study, 135
completed the questionnaire (response rate 65.2%).
Forty-two (20.3%) students decided not to participate
by leaving the class before questionnaire distribution,
and 30 (14.5%) students did not complete the PMPAT
and NPAS portions. The mean age of the participants
was 21.4 ± 0.96 years ranging from 20 to 25 years. Forty-
six percent (N = 62) of the students had participated
in cancer pain management advanced courses/
workshops/ lectures/training outside the universities,
whereas 54% (N = 73) had no training/advanced
courses beyond that offered in their nursing programs.
Eighty-six (63.7%) students cared for cancer patients in
pain previously during their clinical training.
The PMPAT total correct item score ranged from 5
(16%) to 22 (71%) with a total mean correct answer of
11.4 ± 2.9 out of 31 items (total score if all questions
answered correctly), and the rate of correct answer
ranged from 5% (question 7) to 84% (question 8). This
mean score indicated that participants on average
answered only 37% of the questions correctly. None
of the participants achieved complete and correct
responses (31 or 100%). If > 60% was considered as the
passing score, then 1.5% (N = 2) of participants passed
this test (Table 1).
The results show that many questions were
answered incorrectly—mainly those related to areas
of pain physiology and non-pharmacologic pain
management: (1) blood level of analgesia, (2) acute pain
symptoms, (3) theory of gate control, (4) C-fibers and
pain sensation, and (5) use of cutaneous stimulation as
Table 1. Frequency and percentage of knowledge test
scores
Scores Frequency (%)
More than 60% 2 (1.5%)
50%-60% 9 (6.7%)
Less than 50% 124 (91.8%)
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a non-pharmacologic technique as presented in Table 2.
Concerning pharmacologic management, around 62%
(N = 83) of the students accurately defined tolerance
and recognized that Meperdine has severe central
nervous system side effects, and 45.9% (N = 62) of the
students stated the action of naloxone. They knew
the use of combined analgesics achieves cancer pain
control, but only 9% (N = 12) of the students recognized
that the preferred route of pain medications for cancer
patients was oral; 14% (N = 19) of the participants knew
that Methadone as a narcotic pain medication has the
longest duration of action. Interestingly, most students
agreed that the patient is the only reliable source for
pain reporting (60%, N = 81).
The mean NPAS score was 69 ± 5.75 on a test
with scores ranging from 25 to 100. The participants’
scores ranged from 49% to 83% of students reporting
adequate attitudes toward cancer pain management.
Item analysis of the NPAS showed that most nursing
students agreed that (1) continuous assessment of
medication effectiveness and pain is a critical step to
provide good pain management, (2) patients should
have control over their pain medications schedule,
(3) no expression of pain does not indicate absence of
pain, (4) nurse should contact the physician, if patients
still complain of pain after taking pain medications,
and (5) diversion and distraction may reduce patients’
pain level. Students had low scores in using of around-
the-clock dosing and as-needed medications because
of the worry of dependency and risk of respiratory
depression (item 12). Additional findings encompassed
negative attitudes to keeping their patients in pain-
free conditions (item 14), and when it is appropriate for
cancer patients to ask for other pain medications (item
25) (Table 3).
There was a significant weak positive correlation
between knowledge and attitudes of nursing students
toward cancer pain management (r = 0.225, p = 0.009).
This suggested that nursing students with more
information about cancer pain and its management
had more positive attitudes than those with a low level
of knowledge. Age was not correlated to students’
knowledge (r = 0.046, p = 0.595) or attitudes (r = -0.157,
P = 0.069) mean score. Independent t-test was also
used to examine study variables by their demographic
characteristics. There were no significant differences
identified in the students’ knowledge or attitudes mean
scores in term of previous cancer pain management
training/advanced courses and previously cared for
cancer patients in pain (Table 4).
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Table 2. Frequency of correct answers by participants in the knowledge test

Correct Responses
Questions
N %
1. Patients with cancer who suffer from pain (percentage) 38 28.1
2. Patients with cancer who experience pain for more than a month (percentage) 41 30.4
3. The nurse should call the physician if patients continue to have pain 49 36.3
4. Route of analgesics administration for cancer patients 12 9
5. At what level is it appropriate for cancer patient to ask for additional pain medication 21 15.6
6. The accurate and reliable judge of the intensity of pain 81 60
7. Patients who are receiving narcotic analgesics become addicted (percentage) 7 5.2
8. Analgesics mechanism of action 113 83.7
9. Cutaneous stimulation can treat which type of pain 25 18.5
10. Principles underlying narcotic administration in advanced cancer patients 38 28.1
11. Common chronic pain symptoms 67 49.6
12. Methadone has the longest duration of action 19 14
13. Acute pain is usually associated with increased temperature and caloric requirement 41 30.4
14. C -Fibers are accountable for the aching and dull pain sensation 27 20
15. The substantia gelatinosa is responsible for “gating” 55 40.7
16. Pain is modulated by opiate receptors 79 58.5
17. Pain is related to a decrease level of the analgesic in blood 26 19.3
18. Goal of pain management 32 23.7
19. Overall quality of life is the primary factor to consider for cancer patients 73 54.1
20. Factors which impact expression of pain 96 71.1
21. Naloxone mechanism of Action 62 45.9
22. Research indicates nurses under-medicate and physicians under-prescribe 14 10.4
23. Meperidine has more neurotoxicity than Morphine 83 61.5
24. Intravenous drip is the method of administration of steady-state analgesia 36 26.7
25. Steady-state analgesia primary benefit 63 46.7
26. Variables which affect nursing decision 34 25.2
27. Patient has the most control over the schedule of pain management 33 24.4
28. Tolerance (definition) 83 61.5
29. Backrub with heating pad is a cutaneous stimulation example 62 45.9
30. Examples of interruption 67 49.6
31. Managing pain for patients with metastatic cancer using narcotic, anti-inflammatory 62 45.9
PRN: Pro re nata (as needed)

Discussion
The findings of this study showed that knowledge
and attitudes of our nursing students towards cancer
pain management were sub-optimal. A mean score
of 37% on the knowledge test and a mean score of
69% on the attitudes test were seen, suggesting poor
knowledge and negative attitudes towards cancer pain
management. This is well below failing the acceptable
level (80%) for graduate nursing students and below
what we expected. This indicates an obvious problem
in the nursing curriculum in terms of cancer pain
management[20]. Similarly, Iranian and Jordanian
nursing students reported significantly lower levels
of knowledge and attitudes toward cancer pain
management[21,22]. Researchers found that Jordanian
and Iranian nursing students’ mean correct answer
scores on the knowledge test were 34.1% and 37.8%.
Another study conducted in Saudi Arabia also found
a similar finding: that the knowledge of cancer pain
management among most nurses working in oncology
units is generally poor[12]. A higher PMPAT score of 63%
was seen among fourth-year nursing students in the
Nursing College at South Florida University, USA[16].
Nursing students’ low scores in this study may be
due to the scarce time that has been devoted to pain
assessment and management in the nursing curricula.
Such a low score requires the inclusion of cancer pain
assessment and management education in nursing
curricula to improve the knowledge of our nursing
students, which may lead to more positive attitudes
toward cancer pain management.

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Table 3. Frequency of participants with positive responses to attitudes questions

Attitude Question
Frequency Positive
1. Giving analgesia on a regular basis is preferable for continuous pain 97 (71.8) Agreed
2. Patients should complain of pain before administering the next dose of medication 51 (37.6) Disagreed
3. Ongoing evaluation is required for effective pain management 127(94.0) Agreed
4. Patient should expect pain relief as a treatment goal 98 (72.6) Agreed
5. Patients hesitant to use narcotics because of fear of addiction 102 (75.6) Agreed
6. A patient getting narcotic on a PRN is more probable to have behaviors (clock-watching) 96 (71.1) Agreed
7. Estimating pain by nurses is more accurate than patient 63 (46.7) Disagreed
8. Cancer patients can tolerate a high dose of pain medication 55 (40.7) Agreed
9. Patient with cancer has a right to maintain in a pain free condition 95 (70.3) Agreed
10. If patients report euphoria and pain relief, lower doses of the analgesia should be given 40 (29.7) Disagreed
11. Nurses should administer pain medications at regular intervals to patients with chronic pain 72 (53.4) Agreed
12. Cancer patient on around the clock narcotics is at greater risk of respiratory depression and sedation 30 (22.2) Disagreed
13. Patient with acute pain needs a lower dosage of pain medication compared to chronic pain 83 (61.5) Agreed
14. Patient should be sustained in pain-free condition 27 (20.0) Disagreed
15. If there is no expression of pain, it does not indicate that no pain 108 (80.0) Agreed
16. Appropriate treatment can relieve cancer pain 95(70.3) Agreed
17. Nurse should contact the physician, if a patient still complains of pain 126(93.3) Agreed
18. Patients with cancer taking narcotics around the clock can be addicted 36(27.4) Disagreed
19. Diversion and distraction may reduce patients’ pain level 121(89.6) Agreed
20. The blood should contain a constant level of analgesic to control pain 115(85.2) Agreed
21. Physical symptoms and increasing analgesic requirements are signs of addiction 33(24.4) Disagreed
22. Patient must have more control over the schedule of pain medications 73(54.1) Agreed
23. The nurse can evaluate the pain of the patient more accurately than family/ patient 38(28.1) Disagreed
24. Cutaneous stimulation are effective intervention for patients with mild pain 44(32.5) Disagreed
25. The discomfort when patients must ask for additional pain medications when receiving analgesics PRN and having pain 21(15.6) Agreed

Table 4. Differences of nursing students’ knowledge and attitudes mean score based on cancer pain education and caring for
cancer patients in pain
Variables Mean ± SD t-value df P-value
Knowledge (PMPAT) 11.40 ± 2.92
Previous training/advanced courses 1.23 133 0.220
Yes (N = 62) 11.06 ± 2.78
No (N = 73) 11.68 ± 3.02
Previously cared for cancer pain in pain 1.12 132 0.137
Yes (N = 86) 11.32 ± 2.84
No (N = 49) 11.03 ± 2.34
Attitudes (NPMAS) 68.80 ± 5.75
Previous training/advanced courses -0.39 133 0.691
Yes (N = 62) 69.00 ± 5.29
No (N = 73) 68.60 ± 6.14
Previously cared for cancer pain in pain -0.34 131 0.562
Yes (N = 86) 68.65 ± 6.19
No (N = 49) 68.32 ± 5.41
SD: Standard deviation; df: Degrees of freedom; PMPAT: Pain Management Principles Assessment Test; NPAS, Nurses Pain Management Attitudes Survey

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Many areas that were commonly missed in this
study were questions related to the knowledge that
need to alert universities and academic educators to
their deficiencies in the nursing programs. Questions
like the preferred route of narcotic analgesics and
principles of administration, the action of naloxone,
methods of steady-state analgesia, and Meperdine side
effects had a less than 60% pass rate. Nursing students
had negative attitudes regarding cancer patients
taking around-the-clock narcotics and the ability
of these patients to tolerate a high dose of narcotic
analgesia without side effects. Nursing students did
not recognize that respiratory depression and sedation
are rare in cancer patients with high narcotic tolerance.
These findings were similar as in earlier research;
obviously, little progress has been made in this area
over the past 15 years[11,16,20]. This also revealed that
most nursing curricula had no or little cancer pain
management contents, and nursing students were
not well-trained to apply proper pain management
interventions.
Areas where most students had high levels of
cancer pain management knowledge and positive
attitudes included knowing who can best judge cancer
patients’ pain, understanding analgesia mechanism
of action, and questions about factors which impact
expression of pain. This might indicate that nursing
students may have strong theoretical understanding
of general cancer pain concepts, but they do not apply
this knowledge properly in their clinical practice.
The study findings also show that there was a
weak but significant and positive correlation between
knowledge and attitudes of nursing students toward
cancer pain management. Students who had a low
score on the knowledge questionnaire had a similarly
low score on the attitudes’ questionnaire as well. These
findings concur with previous studies among nursing
students and oncology nurses when researchers
found a weak/moderate correlation between nursing
students’ knowledge and attitudes (P < 0.01)[16,23]. There
has been some consistency between similar questions
on the attitudes and knowledge questionnaires. Most
nursing students in this study indicated that additional
as-needed pain medication should not be given until
pain returns on the knowledge test. Students also
confirmed that the patient with cancer should complain
of pain before taking the next dose of pain medication
on the attitude questionnaire. An exaggerated fear of
narcotic-related adverse reactions and addiction was
noted in this study. Healthcare providers’ fear regarding
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addiction is one of the barriers to effective cancer pain
management[4]. These addiction myths are properly
due to insufficient knowledge about opioid analgesics
and their uses. Many nursing students also accurately
defined tolerance on the knowledge questionnaire,
and a large number of students knew that it is very
unlikely that cancer patients will become addicted
to pain medication on the attitudes questionnaire.
Therefore, we noted that the scores of knowledge and
attitudes appear to be related in terms of addiction.
These consistencies may suggest that the knowledge
of nursing students affects their attitudes toward
cancer pain management practices.
Although participation in workshops and
courses on cancer pain management and previously
cared for patients in pain has been shown to have a
significant impact on nursing students’ knowledge
and attitudes toward cancer pain management in
earlier studies[12,22,24], this study did not confirm this.
One study has examined pain management and shares
similar findings with this study[25]. This might be due
to inadequate preparation in continuing nursing
education. Further research studies may require groups
to investigate the relationships between cancer pain
management knowledge and attitudes scores as well
as the demographic characteristics among nursing
students to better explain the relationships.
There are several limitations and strengths to
be taken into consideration in this study. The study
used a cross-sectional design, and therefore cannot
establish causal or temporal relationships between
the variables. Interventional studies are wanted
to assess the effect of cancer pain management
courses/programs on nursing students’ knowledge
and attitudes. Using an English survey among Arabic-
speaking people is another limitation in this study—
this may affect their understanding of the questions.
Nevertheless, this study adds to our understanding
of the psychometric properties of the instruments
used within the context of Saudi nursing students. A
self-administered questionnaire does not allow for
investigation of the nursing students’ actual practice
in the management of cancer pain. Therefore, in future
studies, collecting data through an observational
approach may be more valuable. This is the first study
to ask these specific questions in Saudi Arabia, which
prevents direct comparisons to prior work. Studies
conducted internationally have been used, but these
may have a slightly different curriculum or education.
The good response rate of the nursing students and
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 Evaluating Saudi Nursing Students’ Knowledge and Attitudes toward Cancer Pain Management...
D.Y. Wazqar
the high internal consistency values of the instruments
in this study emphasize that the findings give a clear
picture about the current status of nursing students
in Saudi Arabia. It can be also extrapolated to the
knowledge and attitudes of nursing students in other
cultures and developing countries regarding cancer
pain management due to the curriculum similarity of
nursing colleges.
Conclusions
The purpose of this study was to evaluate the current
knowledge and attitudes regarding cancer pain
management among Saudi nursing students. The
results indicate that there were severe knowledge
deficits and negative attitudes about cancer
pain management among our nursing students.
Inadequate knowledge of cancer pain management
in the baccalaureate nursing curriculum could have a
negative impact on continuing education when nurses
graduate, which consequently impact on the pain
management of cancer patients. This study may provide
academic educators and decision-makers with insight
into the significance of developing a cultural nursing
curriculum involving more information on cancer
pain and its management. There is an urgent need to
incorporate novel teaching strategies and put more
emphasis on pain management and pharmacology
as well as practical skills while nursing students are
in clinical placements. Topics/courses addressing
cancer pain physiology, pharmacology, and non-
pharmacologic pain management strategies as well as
concepts such as addiction, tolerance, and dependence
in the curriculum would be also useful in enhancing
the nursing students’ knowledge and attitudes as
well as the patients’ quality of life. Moreover, clinical
instructors need to emphasize the importance of
regular pain assessment and management practice in
everyday practice. Nursing faculties can change clinical
practice and how patients with cancer receive pain
management. The study findings can serve as baseline
data for use by educators, nurse researchers, oncology
nurses, and nursing administrators to improve the field.
Conflict of Interest
The author has no conflict of interest.
Disclosures
The author did not receive any type of commercial
support either in forms of compensation or financial
68 Journal of King Abdulaziz University - Medical Sciences  Volume 26 No. 2, 2019
for this study. The author has no financial interest in
any of the products or devices, or drugs mentioned in
this article.
Ethical Approval
Obtained.
Acknowledgments
The author would like to thank Ebaa Marrow, Reem
Hassan, and Amal Bahithem, for their help in collecting
data from the study participants.
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 ‫‪Evaluating Saudi Nursing Students’ Knowledge and Attitudes toward Cancer Pain Management...‬‬
‫‪D.Y. Wazqar‬‬

‫ﺗﻘﯿﯿﻢ ﻣﻌﻠﻮﻣﺎت طﺎﻟﺒﺎت اﻟﺘﻤﺮﯾﺾ اﻟﺴﻌﻮدﯾﯿﻦ وﻣﻮاﻗﻔﮭﻢ ﻧﺤﻮﻋﻼج آﻻﻟﻢ اﻟﻤﺼﺎﺣﺐ‬

‫ﻟﻠﺴﺮطﺎن‪ :‬اﻵﺛﺎر اﻟﻤﺘﺮﺗﺒﺔ ﻋﻠﻰ ﺗﻌﻠﯿﻢ اﻟﺘﻤﺮﯾﺾ‬

‫ﺿﺤﻰ ﯾﻮﺳﻒ وزق‬

‫ﻗﺴﻢ اﻟﺘﻤﺮﯾﺾ اﻟﺒﺎطﻨﻲ اﻟﺠﺮاﺣﻲ‬
‫ﻛﻠﯿﺔ اﻟﺘﻤﺮﯾﺾ‪ ،‬ﺟﺎﻣﻌﺔ اﻟﻤﻠﻚ ﻋﺒﺪ اﻟﻌﺰﯾﺰ‬
‫ﺟﺪة ‪ -‬اﻟﻤﻤﻠﻜﺔ اﻟﻌﺮﺑﯿﺔ اﻟﺴﻌﻮدﯾﺔ‬

‫اﻟﻤﺴﺘﺨﻠﺺ‪ .‬ﻋﻼج اﻷﻟﻢ ﻏﯿﺮ اﻟﻔﻌﺎل ﻣﺸﻜﻠﺔ ﻛﺒﯿﺮة ﯾﻮاﺟﮭﮭﺎ اﻟﻌﺪﯾﺪ ﻣﻦ ﻣﺮﺿﻰ اﻟﺴﺮطﺎن‪ .‬ھﻨﺎك ﻧﻘﺺ ﻓﻲ اﻟﺘﺮﻛﯿﺰ ﻋﻠﻰ ﻋﻼج‬
‫اﻷﻟﻢ اﻟﻤﺼﺎﺣﺐ ﻟﻠﺴﺮطﺎن ﻓﻲ ﻣﻨﮭﺞ اﻟﺘﻤﺮﯾﺾ اﻟﺠﺎﻣﻌﻲ وھﻮ ﺟﺰء ﻣﻦ ھﺬه اﻟﻤﺸﻜﻠﺔ‪ .‬أﺟﺮﯾﺖ دراﺳﺔ وﺻﻔﯿﺔ ﻣﺴﺘﻌﺮﺿﺔ ﻣﻊ ﻋﯿﻨﺔ‬
‫ﻣﻼﺋﻤﺔ ﻣﻦ ‪ ١٣٥‬طﺎﻟﺒﺔ ﺗﻤﺮﯾﺾ ﻓﻲ ﺟﺎﻣﻌﺘﯿﻦ ﻓﻲ ﺟﺪة ﺑﺎﻟﻤﻤﻠﻜﺔ اﻟﻌﺮﺑﯿﺔ اﻟﺴﻌﻮدﯾﺔ ﻟﺘﻘﯿﯿﻢ ﻣﻌﺮﻓﺔ اﻟﻄﺎﻟﺒﺎت وﻣﻮاﻗﻔﮭﻢ اﺗﺠﺎه ﻋﻼج‬
‫اﻷﻟﻢ اﻟﻤﺼﺎﺣﺐ ﻟﻠﺴﺮطﺎن‪ .‬ﺗﻢ ﺟﻤﻊ اﻟﺒﯿﺎﻧﺎت ﺑﺎﺳﺘﺨﺪام اﺧﺘﺒﺎر ﺗﻘﯿﯿﻢ ﻣﺒﺎدئ ﻋﻼج اﻷﻟﻢ وﻣﺴﺢ ﻣﻮاﻗﻒ اﻟﻤﻤﺮﺿﺎت‪ .‬ﺗﻢ ﺗﺤﻠﯿﻞ اﻟﺒﯿﺎﻧﺎت‬
‫ﺑﺎﺳﺘﺨﺪام اﻟﺤﺰﻣﺔ اﻹﺣﺼﺎﺋﯿﺔ ‪ IBM‬ﻟﻠﻌﻠﻮم اﻻﺟﺘﻤﺎﻋﯿﺔ ‪ ،‬اﻹﺻﺪار ‪ ، ٢٢‬وﺗﻢ ﺗﻔﺴﯿﺮ ﻧﺴﺒﺔ اﻟﺨﻄﺄ )‪ (P‬اﻟﺘﻲ أﻗﻞ ﻣﻦ ‪ ٠٫٠٥‬ﻛﻨﺴﺒﺔ‬
‫ﻣﻠﺤﻮظﺔ‪ .‬ﺗﻢ إﺟﺮاء اﻹﺣﺼﺎءات اﻟﻮﺻﻔﯿﺔ واﻻﺳﺘﻨﺘﺎﺟﯿﺔ وﻋﻼﻗﺎت ﺑﯿﺮﺳﻮن‪ .‬طﺎﻟﺒﺎت اﻟﺘﻤﺮﯾﺾ ﻟﺪﯾﮭﻢ ﻣﻌﺮﻓﺔ ﻏﯿﺮ ﻛﺎﻓﯿﺔ )‪±١١٫٤‬‬
‫‪ (٢ ٫٩٢‬وﻣﻮاﻗﻔﮭﻢ ﻛﺎﻧﺖ ﺳﻠﺒﯿﺔ )‪ (٥٫٧٥ ± ٦٨٫٨‬اﺗﺠﺎه ﻋﻼج اﻷﻟﻢ اﻟﻤﺼﺎﺣﺐ ﻟﻠﺴﺮطﺎن‪ .‬ﻟﻢ ﺗﺤﻘﻖ أي ﻣﻦ طﺎﻟﺒﺎت اﻟﺘﻤﺮﯾﺾ‬
‫اﺳﺘﺠﺎﺑﺎت ﻛﺎﻣﻠﺔ وﺻﺤﯿﺤﺔ )‪ ٣١‬أو ‪ (٪١٠٠‬ﻓﻲ اﺧﺘﺒﺎر اﻟﻤﻌﺮﻓﺔ‪ .‬ﻛﺎن ﻟﺪى اﻟﻄﺎﻟﺒﺎت ﻣﻌﺮﻓﺔ ﺿﻌﯿﻔﺔ ﻓﯿﻤﺎ ﯾﺘﻌﻠﻖ ﺑﻤﺠﺎﻻت ﻓﺴﯿﻮﻟﻮﺟﯿﺎ‬
‫اﻷﻟﻢ وﺗﻘﯿﯿﻤﮭﺎ‪ ،‬وﻋﻼج اﻷﻟﻢ اﻟﺪواﺋﻲ وﻏﯿﺮ اﻟﺪواﺋﻲ ﻣﺜﻞ اﻟﺘﺤﻔﯿﺰ اﻟﺠﻠﺪي‪ .‬ﻛﻤﺎ ﺗﻢ اﻟﻌﺜﻮر ﻋﻠﻰ ﻋﻼﻗﺔ إﯾﺠﺎﺑﯿﺔ ﺿﻌﯿﻔﺔ ﺑﯿﻦ ﻣﻌﺮﻓﺔ‬
‫اﻟﻄﺎﻟﺒﺎت وﻣﻮاﻗﻔﮭﻢ )‪ .(r =٠٫٢٢٥, p = ٠٫٠٠٩‬ﻣﻄﻠﻮب ﻋﻤﻞ ﻣﺴﺘﻤﺮ ﻟﺘﻄﻮﯾﺮاﺳﺘﺮاﺗﯿﺠﯿﺎت ﻣﺤﺪدة ﻟﺘﻌﻠﯿﻢ طﺎﻟﺒﺎت وطﻼب‬
‫اﻟﺘﻤﺮﯾﺾ ﺑﺸﻜﻞ ﻓﻌﺎل وﺗﻌﺰﯾﺰﻣﻌﺎرﻓﮭﻢ وﻣﻮاﻗﻔﮭﻢ ﺗﺠﺎه ﻋﻼج اﻷﻟﻢ اﻟﻤﺼﺎﺣﺐ ﻟﻠﺴﺮطﺎن‪.‬‬

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